Long-Term Conditions

Headlines

  • Hospital admissions due to asthma, epilepsy and diabetes are similar to the national average among under 19’s in Wakefield
  • Around 0.5% of Under 18’s registered to a Wakefield GP have epilepsy
  • Around 0.2% of Under 18’s registered to a Wakefield GP have diabetes
  • Around 4.6% of Under 18’s registered to a Wakefield GP have asthma

The population

Long term conditions (LTCs) are health conditions that can’t, at present, be cured but can be controlled by medication and therapies. LTCs include diseases such as asthma, diabetes and epilepsy. People with LTCs are more likely to see their GP, be admitted to hospital, stay longer in hospital and children with LTCs are more likely to miss more school if their condition is not controlled.

Asthma

Asthma is the most common long-term medical condition in childhood; approximately 1 in 11 children have it. Local analysis (2019) suggests that 4.3% of children registered to a GP in Wakefield who are under 18 have asthma. This is much higher than the national average, but slightly less than local analysis showed prevalence to be in 2017.
Asthma affects the airways in the lungs. Symptoms include breathlessness, tightness in the chest, coughing and wheezing. The goal of managing asthma successfully is for the person to be free from symptoms and able to lead a normal and active life. This is achieved partly through treatment, and partly by people getting to know what aggravates their symptoms and avoiding these triggers as much as possible.

Diabetes

Diabetes is a long-term condition which affects the body’s ability to produce insulin; a hormone which allows the body to absorb sugars from food. Without insulin, sugar builds up in the blood and cause significant damage to a person’s heart, eyes, feet and kidneys over time if not managed properly.  There are about 35,000 children and young people with diabetes, under the age of 19, in the UK. 98% of these have Type 1 diabetes, and require regular blood sugar monitoring and insulin injections to manage the condition. Local analysis (2019) shows that 0.2% of Under 18 year olds in Wakefield, who are registered to a Wakefield GP, have diabetes.

Epilepsy

Epiepsy is a neurological condition which can cause people to have seizures which start in the brain, even though the symptoms may affect all of the nervous system. Seizures can take place in different forms, such as physical convulsions (jerking of the body), repetitive movements, unusual sensations or brief periods of absence which are often mistaken for ‘daydreaming’. In the UK, epilepsy affects around 1 in every 200 child under the age of 18. Locally, the estimated prevalence of epilepsy is around 0.5%, which equates to over 300 children in the District (2019). It can start at any age, and may also change or stop throughout childhood. Epilepsy may develop as a result of a brain injury, infection or genetic factors and can vary in severity.

The Challenges

Enhancing the quality of life for people with LTCs is a priority for the NHS; a key area of focus is reducing the time spent in hospital by people with LTCs. Unplanned hospitalisation for asthma, diabetes and epilepsy in children aged under 19 is the indicator used to measure improvement. The rate for Wakefield is lower in 2013/14, at 356.3 (admissions per 100,000), than it was in 2010/11 (377.6); however, the rate is significantly higher than the England average (311.4). Again, the rate for Wakefield Central (493.1) is significantly higher than the rates in the other areas.

Source: Public Health Outcomes Framework

Hospital admissions for asthma

Comparative data on asthma and other long-term conditions is generally limited to hospital admissions; asthma prevalence data is available, but this is for all ages, not specifically children. In 2017/18, admission rates for asthma in Wakefield (148.7 admissions per 100,000 population aged under 19) were slightly better than the national and regional averages (England = 186.4, Region = 171.6). There were a total of 112 hospital admissions for people aged under 19 because of asthma. The overall trend shows that the rate of asthma admissions for 0-18 year olds in Wakefield is decreasing, following a brief increase last year.

Hospital admissions for diabetes

In 2016/17, there were 62 hospital admissions in Wakefield for diabetes in children aged 0-18. This equates to a rate of 83.5 per 100,000 young people. This is worse than both the regional (60.4 per 100,000) and England average (55.1 per 100,000). This is a large increase from the previous year where there rate of hospital admissions for diabetes in Wakefield in children was 62.1 per 100,000. The most recent trend shows that this admission rate is steadily increasing despite decreases in the past.

Hospital admissions for epilepsy

The rate of hospital admissions for epilepsy in Wakefield has remained fairly consistent over the past few years. In 2016/17, there were 55 admissions for epilepsy in the 0-18 age group, slightly more than in 2015/16 (56). In 2016/17 this equated to a rate of 74.1 admissions per 100,000 children, which is similar to the regional and national averages (74.2 per 100,000 and 72.1 per 100,000 respectively).

The Inequality

Nationally there are wide variations in outcomes for people living with asthma, with hospital admissions for asthma being 6 times higher in certain areas. These variations can also be seen in Wakefield. Previous analysis has shown that Wakefield Central has the highest rate of emergency admissions for asthma in person aged under 20 years; the rate of 307.5 per 100,000 was significantly higher than the rates in the other areas.

Local analysis (2019) also show the estimated prevalence of asthma also varies within the district; the two wards Hemsworth and Horbury and South Ossett have a significantly higher asthma prevalence than the district average. There is minimal variation to be seen in epilepsy and diabetes across the district, mainly due to low prevalence rates.

Service Provision

Locally, there are services to support children with long-term health conditions.

Locally, specialist nursing services exist for asthma and diabetes. These are usually accessible via a GP and provide reviews at least once a year to ensure their conditions are well controlled. Schools are also now more able to support children with long-term conditions; school nurses are trained to support children with diabetes and asthma in particular, and provide healthcare plans for schools.

Within Mid Yorkshire Hospitals Trust there is a specialist epilepsy nurse for complex and resistant epilepsy cases who can be accessed by children and families.